There is an increasing awareness of high burnout found among physicians. Resident physicians particularly face heightened stress due to inherent pressures of training in addition to systemic challenges common to healthcare. It is crucial that medical training programs and organizations create a culture which promotes physician well-being. We conducted an evaluation of a quality assurance pilot program aimed at creating a safe space for increasing burnout awareness and well-being among resident physicians. The program was voluntary, offered to psychiatry residents enrolled at McMaster University, and comprised an online resilience curriculum, peer groups, and wellness newsletters. Data analysis took place between December 15, 2018 and July 15, 2019. The educational goals were evaluated by outcome measures obtained over time in aggregated response data through residents' anonymous survey feedback. All aspects of the triad received positive feedback, with peer groups being perceived as most helpful. Of all residents, 31% (n = 22) engaged in all three aspects of the program; the majority were female (83%) and senior residents (63%). While 48% reported burnout upon enrollment, there was an average 50% stress reduction perceived post-attendance. This project has shown that peer groups can make a difference A. Hategan ( ) in the daily experience of psychiatry residents at our institution.Keywords Resident physician burnout · Physician wellness · Physician well-being · Resilience · Curriculum development Bridging the gap: Responding to resident burnout and restoring well-being 117

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Background Residency training is associated with risks of burnout and impaired well-being. This may be due to multiple factors, including navigating various transitions. Chief among these is the transition to independent practice which, in Canada, involves a certification exam administered by the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada. This qualitative study explored the experience of residents in their examination year, including residents impacted by pandemic-related examination postponment, to understand how these experiences may impact residents’ well-being. Methods Qualitative description methodology was used for this study. Participants were residents and physicians in independent practice from McMaster University and the University of Toronto. In depth, semi-structured, one-on-one interviews were conducted by one of the investigators. Each was transcribed, reviewed, and coded by two members of the investigating team. Results Five themes were identified. Examinations were perceived to be a significant stressor, and the extent of preparation involved was viewed as a threat to one’s physical and mental well-being. Participants identified a culture of fear surrounding the exam, as well as a perception that exam preparation requires significant sacrifice which can exacerbate the impacts of the exam year. Personal and professional supports were identified as important protective factors. Conclusion This study has identified unique challenges in the examination year, and its impact on the well-being of residents immediately before they enter independent practice. Residents also experienced significant learning and a sense of accomplishment through their preparation for the examination. The COVID-19 pandemic had a unique impact on one cohort of residents. This should prompt medical education institutions to examine the support provided to residents, the culture surrounding certification examinations, and mitigation strategies for future examination disruptions.

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